Elderly prisoners with serious chronic medical conditions, 3%

inmates are the fastest growing in the United States prison populations, which
poses difficult challenges for correctional and public health entities and
dying alone in prison can be merciless. Prisoners not having family, friends,
or any visitors while incarcerated usually die a lonely, painful, isolated
death. Hospice programs, in prisons, started in the late 1980s due to increased
deaths of prisoners with Acquired Immunodeficiency Syndrome (AIDS) to be
addressed in two prisons, one in Springfield Missouri and the other in
Vacaville, California.  Because of these
two prisons, others started to adopt the hospice programs to provide dying
prisoners’ humane treatment and to not have to die alone. Dignity,
communicating respect, and compassion among prison staff and prisoners were
brought about through hospice (Wright & Bronstein 2007).

U.S. Medical Center for Prisoners, opened the first prison hospice, in
Springfield, Mo, in 1987. The dedication and interest of a master’s prepared
psychotherapist, Fleet Maull, incarcerated for drug trafficking, the hospice
movement began. Sentenced to 25 years, during the 14 years served, he taught
meditation to fellow inmates and developed the momentum that lead to hospice
care for prisoners. Hospice first began as a volunteer visitation program and
not a program for medical care. Maull believed “hospice restores humanity by
giving both guards and prisoners permission to care,” (Head, 2005).

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Federal Bureau of Justice Statistics found that the incidence and prevalence of
chronic illness in the prison population are quickly rising. Nationwide, there
is 42.8% of prisoners with serious chronic medical conditions, 3% are more
likely to have asthma, 55% diabetes, and 90% suffer a heart attack, compared to
other Americans of the same age. Those who had been in prison after 72 months
reporting medical problems are the greatest, 30.4%. With the increase of
elderly prisoners that have complex medical and mental health issues, correctional
institutions are required to provide a variety of health services, including
end-of-life (EOL) care. There are more than thirty-five U.S. state prisons that
now have hospice and palliative care programs to care for prisoners at the EOL (Supiano,
Cloyes, & Berry, 2014).

A major contribution for the prison hospice movement was
made by the Robert Wood Johnson Foundation, which funded the Cuiding Responsive
Action in Corrections at End of Life (GRACE) Project, an initiative of the lead
partner, Volunteers of America. Many ways of intervention were demonstrated to
improve pilot sites, (McCain Correctional Hospital Hospice in North Carolina,
Coxsackie Regional Medical Unit, Hospice of the New York Department of
Correctional Services, and the Federal Medical Center Carswell in Texas) for
the hospice program funds, which allowed for the establishment of a resource
center, development of standards, and a handbook for correctional end-of life
care. In 1996, the establishment of hospice services for terminally ill
prisoners, who qualified, were supported by a compassionate release program
initiated by the American Correctional Association Task Force. Also, the nature
of prisoners with terminal illness, procedures to direct treatment and written
policies were developed by the group (Head, 2005).

GRACE Project, learned the efforts and identified all the current end-of-life
programs by examining the 1988, Prison-Based Hospice and Palliative Care
Programs’ survey data collected on 53 correctional jurisdictions, by the
National Institute of Corrections (NIC). The information collected for the
end-of-life care program to be put into place; goals, benefits, and problems
that might come about, funding, policies and procedures, legal issues,
licensing, inmate deaths, services provided, inmate eligibility requirements,
inmate classification, staffing, the use of inmate volunteers, community
involvement and family roles, resources and needs. The programs were usually
developed by individual hospice champions in the prison, which included chaplains,
wardens, administrators, local hospices or hospitals and the National Prison
Hospice Association, but took anywhere from a few months to several years to
plan. The program was not authorized or restricted by any laws. A legal
competency, guardianship, and the requirement for do-not-resuscitate orders are,
the fewer legal problems (Ratcliff, & Cohn, 2000).

quality end-of-life care provided in prisons
is not an easy task and present great challenges for prison physicians: 1)
inmate and staff movement restrictions, 2) urgent facilities have limited
access, 3) pharmacy formulary restriction, which causes a barrier on
administering medicine on an as needed basis, 5) patient autonomy limited, and
6) do-not-resuscitate (DNR) orders restriction and advance medical directives. Palliative care treatment for inmates are simplified by some
policies or statues. Prisoners are not allowed to participate in a clinical
trial due to laws that protect inmates from unethical research practices. Even
though treatment options are limited, to transition from disease-directed
therapy in palliative care, makes the decision simple. Physicians use all of
their communications and palliative skills on the challenges of correctional
hospice (Linda & Myers, 2007).

 Aaron Grice, 66, was diagnosed with thymus
cancer. The cancer has spread to his liver and in February, he was moved to
hospice and told he had less than six months to live. Grice deals with physical
and emotional pain of what led him to prison, as his life is coming to an end. His
wife and son wants him to be home with family in the Sacramento area, but he
will most likely die in prison where he has been since October 1985, for
burglary and attempted murder. He does not like for his wife and son to visit
because of the hurt on his wife’s face, she blames herself for his crime. Grice
requested in April to be released from his sentence and be allowed to go home
and die, but he has yet to receive an answer from the Compassionate Release. But
Grice says he is ready for the end. “I stand on God’s promise, I have always
been a Christian,” he said about being at peace with his death (Robinson, 2017).

The Dixon Correctional Center (DCC) in
Illinois is 1 of 20 prison that have inmates as hospice volunteers. There are
two hospice programs in the (DCC): 1) hospice program that tries to follow community
standards, and 2) adult care program that takes care of any inmates with mental
or physical frailness. Every inmate should die with dignity, the basic concept
of hospice, and it is fitting to provide hospice even in prison. The
opportunity for inmates to give back in a humane way to other inmates is by
becoming a hospice volunteer (Cichowlas
& Chen, 2010).

The Dixon Correctional Center had an
increase from 278 to 706, 65 year old prisoners, from June 2005 to June 2014.
Hospice volunteer, Earl Johnson received an 80 year sentence for killing a man
while robbing a store. He wanted keep his humility and also soften the
harshness of prison life, so he volunteered to work with hospice patients.
Johnson had a friendship with his patient that he did not have with other
prisoners. Inmate volunteers are called upon at 2 a.m., as a patient’s life is
coming to an end, the prison hospice tries to arrange a 24-hour vigil. Earl was
with his patient almost every day until he passed away on June 8, but others
were with him when he died (Zbisniew, 2014).

there are a lot of outcomes of prison hospice. The cost-effectiveness of prison
hospice is one of the most important outcomes. With hospice care for dying
inmates, trips to hospitals, security needed for the trips, and having to stay
at a medical facility is not necessary, removed extensive costs for correctional
institutions and society. Hospice volunteers that took care of dying patients
were changed by their work of looking after someone and expressing love. The
positive effect on the volunteers can give them a bigger opportunity for
psychological rehabilitation. By other inmates seeing how the volunteers
provide care for dying prisoners could have an impact on the entire prison
population that even prisoners have the right to die with dignity. Terminally
ill prisoners got to experience the comfort of care and the benefit to be able
to stay memorable areas, support of inmate volunteers, being around other
people they knew, and that they would not be alone when their life ended (Yampolskaya, & Winston, 2003).

Therefore, personal, social and political conflicts in regards to
crime and corruption, add to tensions between theory and practice, even though
health care is a prisoners’ right. For dying prisoners, and their families,
jail authorities, medicinal services suppliers, and different individuals from
palliative care groups who try to accomplish or encourage a decent death of the
dying inside the surroundings of the argumentative domain of revisions, they
are faced with perplexed concerns. Although a few advances have been made for the
care and support of dying prisoners, further efforts are required to enhance
access to palliative care, and make open doors for a decent death for those dying
while incarcerated (Burles,
Peternelj-Taylor, & Holtslander, 2016).

exertion to provide palliative care to dying inmates is increasing across the
country. Terminally ill inmates can die with dignity with the help of hospice
prison care volunteers, by not having to die alone. The establishment of
hospice prison care has become even more important because of the current
society focus on cost control and the efficiency of correctional facilities. For
the number of prison hospices to be increased and be of good quality, social
policy and national quality assurance standards should be developed as well as general
guidelines for all prison hospice care programs to follow (Yampolskaya, & Winston, 2003).         

It can be a humbling experience for a
prisoner before being incarcerated, considered himself to be a tough hard core
individual.  But, to take care of an
inmate for a long period and share a bond can have a big impact on a prisoner
to have to watch the patient die. By the inmate not having to die alone, he can
rest in peace knowing other prisoners were by his side.


Burles, M. C., Peternelj-Taylor, C. A., &
Holtslander, L. (2016). A ‘good death’ for all: Examining issues for palliative
care in correctional settings. Mortality, 21(2), 93-111.

Cichowlas, J. A., & Chen, Y. a. (2010). Volunteer
Prisoners Provide Hospice to Dying Inmates. Annals Of Health Law, 19(1),

Head, B. (2005). The transforming power of prison
hospice: Changing the culture of Incarceration one life at a time. Journal Of
Hospice & Palliative Nursing, 7(6), 354-361.

J. F., & Meyers, F. J. (2007). Palliative care for prison inmates:
“don’t let me die in prison”. Jama, 298(8),

Robinson, S. (2017). Prison hospice offers redemption for
patients and workers. Prison hospice
offers redemption for patients and workers. Retrieved from https://csumb.edu/justiceproject/prison-hospice-offers-redemption-patients-and-workers.

Ratcliff, M., &
Cohn, F. (2000). Hospice with GRACE. Corrections Today, 62(1),

Supiano, K. P., Cloyes, K. G., & Berry, P. H. (2014).
The grief experience of prison inmate hospice volunteer caregivers. Journal
Of Social Work In End-Of-Life & Palliative Care, 10(1), 80-94.

K. & Bronstein, L (2007). Creating decent prisons: A serendipitous finding
about prison hospice. Journal of Offender
Rehabilitation, 44(2), 1-16.

Yampolskaya, S., & Winston, N. (2003). Hospice
care in prison: General principles. American Journal of
Hospice & Palliative Care, 20(4), 290-296.

B. (2014). Illinois prison hospice offers care, redemption. Chicago Tribune.
Retrieved from: www.chicagotribune.com/news/ct-prison-hospice